Medical Benefits

Deductible
(Individual/Family)

$2,500 / $5,000

Member Coinsurance

Member pays: 20%

Cigna pays: 80%

Out-of-Pocket Max
(Individual/Family)

$6,500 / $13,000

Office Visits
(General Medicine/Mental Health)

$40 Copay (PCP)

$40 Copay (SPC)

$40 Copay (Virtual)

Preventive Care

100%

Inpatient & Outpatient Hospital Services

Deductible then 20%

Lab & Xray

Office Visit Copay (physician office)

Deductible then 20% (independent lab)

Advanced Radiology (MRI's, PET, CT, etc.)

Deductible then 20%

Urgent Care

$75 Copay

Emergency Room

$250 Copay plus
Deductible then 20%

Prescription Drugs
Generic/Preferred?Non-Preferred/Specialty

$10 / $35 / $70 / Deductible + 20%

$30 / $105 / $210 / Deductible + 20%

Employee Only

$140.00

$796.23

Employee + Spouse

$660.00

$1,672.07

Employee + Child(ren)

$515.00

$1,512.82

Employee + Family

$1,080.00

$2,393.69

Deductible
(Individual/Family)

$1,000 / $2,000

Member Coinsurance

Member pays: 20%

Cigna pays: 80%

Out-of-Pocket Max
(Individual/Family)

$4,500 / $9,000

Office Visits
(General Medicine/Mental Health)

$25 Copay (PCP/Virtual)

$50 Copay (SPC/Virtual)

Preventive Care

100%

Inpatient & Outpatient Hospital Services

Deductible then 20%

Lab & Xray

Office Visit Copay (physician office)

Deductible then 20% (independent lab)

Advanced Radiology (MRI’s, PET, CT, etc.)

Deductible then 20%

Urgent Care

$50 Copay

Emergency Room

$150 Copay plus
Deductible then 20%

Prescription Drugs

Generic/Preferred/Non-Preferred/Specialty

$10 / $30 / $50 / Deductible + 20%

$30 / $90 / $150 / Deductible + 20%

Employee Only

$195.00

$853.37

Employee + Spouse

$680.00

$1,792.08

Employee + Child(ren)

$625.00

$1,621.40

Employee + Family

$1,250.00

$2,560.11

Deductible
(Individual/Family)

$500 / $1,000

Member Coinsurance

Member pays: 10%

Cigna pays: 90%

Out-of-Pocket Max
(Individual/Family)

$3,500 / $7,000

Office Visits
(General Medicine/Mental Health)

$25 Copay (PCP/Virtual)

$50 Copay (SPC/Virtual)

Preventive Care

100%

Inpatient & Outpatient Hospital Services

Deductible then 10%

Lab & Xray

Office Visit Copay (physician office)

Deductible then 10% (independent lab)

Advanced Radiology (MRI’s, PET, CT, etc.)

Deductible then 10%

Urgent Care

$50 Copay

Emergency Room

$150 Copay plus
Deductible then 10%

Prescription Drugs

Generic/Preferred/Non-Preferred/Specialty

$10 / $35 / $70 / Deductible + 10%

$30 / $90 / $150 / Deductible + 10%

Employee Only

$245.00

$899.91

Employee + Spouse

$780.00

$1,889.84

Employee + Child(ren)

$720.00

$1,709.86

Employee + Family

$1,385.00

$2,699.76

Deductible
(Individual/Family)

$5,000 / $10,000

Member Coinsurance

Member pays: 0%

Cigna pays: 100%

Out-of-Pocket Max
(Individual/Family)

$5,000 / $10,000

Office Visits

(General Medicine/Mental Health)

Deductible then 0%

Preventive Care

100%

Inpatient & Outpatient Hospital Services

Deductible then 0%

Lab & Xray

Deductible then 0%

Advanced Radiology (MRI’s, PET, CT, etc.)

Deductible then 0%

Urgent Care

Deductible then 0%

Emergency Room

Deductible then 0%

Prescription Drugs

Generic/Preferred/Non-Preferred/Specialty

Deductible then 0%

Employee Only

$30.00

$688.26

Employee + Spouse

$430.00

$1,445.34

Employee + Child(ren)

$310.00

$1,307.68

Employee + Family

$750.00

$2,064.75

Deductible
(Individual/Family)

$3,400 / $6,800

Member Coinsurance

Member pays: 0%

Cigna pays: 100%

Out-of-Pocket Max
(Individual/Family)

$3,400 / $6,800

Office Visits

(General Medicine/Mental Health)

Deductible then 0%

Preventive Care

100%

Inpatient & Outpatient Hospital Services

Deductible then 0%

Lab & Xray

Deductible then 0%

Advanced Radiology (MRI’s, PET, CT, etc.)

Deductible then 0%

Urgent Care

Deductible then 0%

Emergency Room

Deductible then 0%

Prescription Drugs

Generic/Preferred/Non-Preferred/Specialty

Deductible then 0%

Employee Only

$85.00

$744.39

Employee + Spouse

$550.00

$1,563.24

Employee + Child(ren)

$415.00

$1,414.33

Employee + Family

$920.00

$2,233.19